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Med Surg 1,1
Med Surg 1 Test 1
| Question | Answer |
|---|---|
| Acidosis | Serum pH between 7.35 and 6.8 |
| Metabolic Acidosis | Acidosis due to reduced bicarbonate concentration |
| Respiratory Acidosis | Acidosis due to increased PCO2 |
| Active transport | A physiological pump that uses energy to transport fluid against the concentration gradient |
| Alkalosis | Blood pH between 7.45 and 7.8 |
| Metabolic Alkalosis | Alkalosis caused by high bicarbonate concentration |
| Respiratory Alkalosis | Alkalosis due to low PCO2 |
| Diffusion | Solutes moving down the concentration gradient; passive |
| Homeostasis | Maintainence of a constant internal environment in a biological system by negative feedback mechanisms |
| Hydostatic pressure | The pressure of the weight of fluid against a wall. It drives filtration |
| Hypertonic | A solution with a relatively higher osmolality |
| Hypotonic | A solution with a relatively lower osmolality |
| Isotonic | Two solutions with the same osmolality |
| Osmolality | osmoles (unit of osmolality) per kilogram mOsm/kg |
| Osmolarity | mOsm/L |
| Osmosis | The movement of fluid across a semi-periable barrier from an area of low solute concentration to an area of high solute concentration passive |
| Tonacity | Fluid tension that describes the relationship between solutes and water; primarily determined by osmolality |
| Osmolality tests | The solute concentration per kilogram in serum and urine. Measured in mOsm/kg |
| Normal serum Osmolality | 280- 300 mOsm/kg |
| Normal urine Osmolality | 200 - 800 mOsm/kg |
| % fluid body weight of adults | 60% |
| 3 groups of people who have less body fluids and more fat | Older people, women, obese |
| 2 major compartments of fluid and % | Intracellular 2/3 (ICF), Extracellular 1/3 (ECF) |
| 3 compartments of extracellular fluid | Interstitial, intravascular, transcellular |
| Intravascular, d, amount | Serum. 6L |
| Interstitial , d, amount | Fluid surrounding the cells, 12L |
| transcellular , d, amount | Fluid contained in seperate compartments, Cerebrospinal fluid ect. 1L |
| Third spacing | Loss of ECF into a space that does not contribute to the equilibrium between the ICF and the ECF |
| Evidence of third spacing | A decrease in urine output despite adequate fluid intake |
| Electrolytes | Charged particles in the body fluid |
| major cation electrolytes | Sodium, potassium, calcium, magnesium, hydrogen |
| major anion electrolytes | Chloride, bicarbonate, sulfate, phosphate |
| Electrolyte concentrations measured in? What does it measure? | mEq/L A measure of chemical activity |
| Electrolyte concentrations is measured most often in? | Plasma |
| How does the body maintain sodium/ potassium concentrations ICF and ECF? | Active transport with the sodium/potassium pump |
| Cause of movement at the arterial end of a capilary? | hydrostatic pressure (Push) forces fluid from the intravascular fluid into the interstitial fluid |
| Cause of movement at the venous end of the capillary? | Osmotic pressure (pull) pulls fluid from the interstitial fluid to the intravascular fluid |
| osmotic pressure | the amount of hydrostatic pressure needed to stop the flow of water by osmosis. |
| The kidneys filters how much? What drives it? | 170L/day. Driven by the heart |
| Average fluid intake; 3 subgroups | 2.6L/day; 1.3L oral liquids, 1L water in food, 300mL water produced in metabolism |
| Average fluid loss per day; 4 categories | 2.6L; 1.5L urine, 200mL feces, 300mL lungs, 600mL skin |
| What increases insensible water loss? | Fever |
| Urine specific gravity measures? Normal values? | The kidneys ability to excrete and conserve water. 1.01 to 1.025 |
| Basic Urea nitrogen measures? Normal Values? | BUN measures urea, the end product of the metabolism of protein. normal values 10-20 mg/dL |
| Serum creatinine d., test of, normal values | Creatinine is the end product of muscle metablolism. Good measure of renal function. Normal values 0.7 to 1.4 mg/dL |
| Hematocrit d, normal values men and women | volume of red blood cells in whole blood, normal for men 42% to 52%. Normal for women 35% to 47 %. |
| Normal urine sodium values | 75 to 200 mEq/day |
| 4 major functions of kidney | 1 regulation of ECF volume 2 regulation of electrolytes 3 regulation of pH 4 Excretion of wastes |
| Dec. plasma levels leads to... | stimulates thirst, production of ADH, production of aldosterone, ADH and aldosterone lead to dec. production of urine (more concetrated) which leads to restored plasma levels |
| ADH | Antidieretic hormone- it promotes the retention of water by the kidneys |
| Aldosterone | Increased aldosterone levels cause sodium retention and potassium loss which leads to water retention |
| Decreased stimulation of baroreceptors leads to ... | stimulation of the sympathetic nervous system which leads to increased cardiac rate |
| Angiotensen 2 causes | Vasoconstriction, increased filtration pressure in the capillaries, increased thirst |
| The most significant factor in determining if urine is concentrated or dilute | ADH |
| Osmoreceptors sense, cause | Sense an increase in sodium concentration, cause the release of ADH |
| Atrial Natriuretic Peptide actions | Decreases blood pressure and volume |
| How does hypovolemia differ from dehydration? | Hypovolemia contains the same electrolyte ratios, dehydration is water loss only |
| 12 assessments of hypovolemia | History, orthostatic hypotention, thirst, I&O, weight, vital signs, dry mouth, lung sounds, skin color and temperature, level of consciousness, skin turgur, pitting edema, capillary refill |
| 4 lab data signs of hypovolemia | high BUN to serum creatinine, high hematocrit, high urine specific gravity, high urine osmolality |
| Loss of over 25% of fluid volume can result in? | Shock |
| 1L of body fluid weighs | 2.2 lbs or 1 kg |
| Hypervolemia | Fluid Volume Excess with the same proportion of electrolytes |
| 4 contributing factors to hypervolemia | Poor functioning of heart, liver, kidney or excess salt |
| 2 lab results for hypervolemia | Low BUN and low hematocrit due to plasma dilution |
| Diuretics are prescribed for hypervolemia when... | the dietary restriction of sodium is insufficient to limit edema |
| Possible side effect of diuretics | electorlyte imbalance especially hypokalemia, low potassium |
| Normal Na+ values | 135-145 mEq/L |
| In hyponatremia the cell ? | Swells |
| What is the limit of Na+ increase in a 24 hour period? | 12mEq/L |
| 2 treatments of hyponatremia | sodium replacement and water restriction |
| Which method of treating hyponatremia is safer? | Water restriction, limit to 800 mL/day |
| A primary characterist of hypernatremia? | Thirst |
| The treatment of hypernatremia? | Gradually lowering serum sodium by infusion of a hypotonic electrolyte solution or an isotaonic non saline solution |
| What is the general rule for decreasing serum sodium levels? | No more than 1mEq/L/hr |
| Normal serum potassium | 3.5-5 mEq/L |
| A potential cause of hypokalemia | Diuretics |
| Max concentration of potassium that should be administered? | 20 mEq/L |
| What should be monitored by lab tests in IV potassium treatment? | Renal function by BUN and creatinine levels. |
| Hyperkalemia seldom occurs except? | In patients with impaired renal function |
| How dangerous is hyperkalemia? Why? | Very, high potassium levels can lead to heart attacks |
| Acidosis and potassium | In acidosis, potassium moves out of the cell into the ECF |
| Normal Ca+ serum levels | 8.6 to 10.2 mg/dL |
| How is calcium excreted? | Primarily in the feces, with some excreted in the urine. |
| Serum calcium levels are controled by | PTH and cancitonin |
| What are 2 primary causes for hypocalcemia? | Elevated phosphate levels, and vit D deficiency |
| 2 factors which must be considered in evaluating serum calcium levels? | serum albumin level and arterial pH |
| Low albumin levels and calcium serum calculations? | Low albumin levels lead to underestimations of calcium |
| Calcium and alkalosis? | In alkalosis, more calciuim is bound to protein |
| During treatment for hypocalcemia, what nutrient must be added to help with the absorption of calcium? | Vitamin D |
| For treatment of hypocalcemia, what should dietary calcium be raised to? | 1000-1500 mg/day |
| The most common causes of hypercalcemia? | Malignancies and hyperparathyroidism |
| Hypercalcemia and neuromuscular activity | Hypercalcemia reduces neuromuscular activity because it suppresses activity at the neuromuscular junctions |
| 4 treatment measures o hypercalcemia | 1) Dilute the serum levels with fluids 2) increase excretion 3) restrict dietary calcium 4) mobilize the patient |
| Can calcitonin be used to lower serum calcium levels? | yes |
| Why is fiber important in the treatment of hypercalcemia? | It reduces the chance for constipation. Calcium is primarily removed in the feces |
| Uses of magnesium | Role in enzyme activity and roles in carbohydrate and protein metabolism |
| Normal serum levels of Ca | 1.3- 2.3 mg/dL |
| Magnesium imbalance is important in? | neuromuscular function |
| Magnesium produces a (sedative/stimulant) effect on the neuromuscular junction, probably by (stimulating/ inhibiting) the neurotransmitter Acetylcholine | sedative/ inhibiting |
| magnesium affects the cardiovascular system by? | Peripheral vasodilation |
| Hypomagnesium is associated with? | Hypokalemia and hypocalcemia |
| Decrease in serum albumin levels can (decrease/ increase) magnesium levels? | decrease |
| The most common cause of hypomagnesium in the U.S. | Alcoholism |
| The most common cause of hypermagnesium | Renal failure |
| Importance of phosphorus | 1) Needed for muscle function 2) needed for red blood cell and hemoglobin function 3) Helps with ATP formation 4) Helps with acid/base balance 5) Used in the nervous system 6) important in metabolism of energy nutrients 7) support to bones and teeth |
| Phosphorus is primarily found in (ECF/ICF) | intracellular fluid |
| Normal plasma levels of phosphorus | 2.5 to 4.5 mg/dL |
| Important causes of hypophosphatemia | Alcoholism, excessive intake of simple carbohydrates |
| Decreased calcium may be caused by a decrease in shat nutrient? | Vitamen D |
| Most of the symptoms of hypophosphatemia result from? | deficiency of ATP or hemoglobin impairment |
| Most common cause of hyperphosphatemia? | Renal failure |
| Relationship between phophorus and calcium? | Reciprocal |
| Most cloride is found? | ECF |
| Normal serum levels of cholride? | 97-107 mEq/L |
| SErum osmolality and chloride levels? | Serum osmolality parrallels chloride levels well |
| Bicarbonate and chloride | have an inverse relationship (both anions) |
| When chloride levels are affected what 2 other electrolyte levels are affected? | Sodium and Bicarbonate |
| Chloride assistes with? | Acid base balance |
| The symptoms of hypochlormia are? | those of acid/ base and electrolyte imbalances |
| Hypochloremia and water? | Water loss may occur (because of the loss of sodium along with chloride) |
| Symptoms of hyperchloremia? | Those of metabolic acidosis |
| Two measures used to determine the acid/base balance? | Bicarbonate/ Carbonic acid balance in arterial blood gasses and the anion gap |
| Normal anion gap levels | 8 to 12 mEq/L |
| A high anion gap may mean? | metabolic acidosis |
Created by:
twininger1
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